Effects of Emollient Containing Bee Venom on Atopic Dermatitis: A Double-Blinded,Randomized, Base-Controlled,Multicenter Study of 136 Patients

BackgroundAtopic dermatitis (AD) is a common, complex disease that follows a chronic relapsing course and significantly affects the quality of life of patients. Skin barrier dysfunction and inflammatory processes induce and aggravate this skin condition. Proper use of an emollient for hydration is a keystone of AD treatment. Bee venom is known to have anti-inflammatory effects and has been widely used in traditional medicine to treat various inflammatory disorders.ObjectiveTo find out the beneficial effect of an emollient containing bee venom in the treatment of patients with AD.MethodsThis study included 136 patients with AD who were randomized to receive either an emollient containing bee venom and silk-protein or a vehicle that was identical except for the bee venom for 4 weeks. The patients were instructed to apply the emollient twice daily on their entire body and not to use other medications, including topicals, during the course of the study. The eczema area and severity index (EASI) score, transepidermal water loss, and visual analogue scale (VAS) score of itching were evaluated at the first visit and after 2 and 4 weeks. The investigator global assessment was evaluated at 2 and 4 weeks after the application of emollient containing bee venom or vehicle.ResultsPatients applying emollient containing bee venom showed significantly lower EASI score and VAS value compared to patients applying emollient without bee venom.ConclusionEmollient containing bee venom is a safe and effective option for patients with AD.     

他克莫司软膏治疗儿童特应性皮炎的临床研究

目的　评价他克莫司软膏治疗儿童特应性皮炎 (AD)的疗效与安全性。方法　采用随机、双盲、赋形剂对照临床研究方法,将 36例儿童AD患者随机分为两组,按 1∶1比例分别接受 0. 03%他克莫司软膏或赋形剂治疗,观察治疗第 1, 2和 3周的临床疗效和不良反应。结果　0. 03%他克莫司软膏组有效率为 83. 3% (15 /18),明显高于赋形剂组的 27. 8% (5 /18),差异非常显著(P<0. 001);总体疗效比较,他克莫司软膏组亦优于赋形剂组 (P=0. 002);治疗后第 1,2, 3周患者的主要症状 /体征指标平均值均明显低于赋形剂组,组间差异显著(P<0.01~P<0. 05),治疗后患者的生活质量亦明显改善。药物相关不良反应主要表现为一过性局部刺激,组间比较差异无显著性 (P>0. 05)。两组患者均未出现严重不良反应。结论　0. 03%他克莫司软膏治疗儿童特应性皮炎安全有效。     

Antibiotic Susceptibility of Staphylococcus aureus in Atopic Dermatitis: Current Prevalence of Methicillin-Resistant Staphylococcus aureus in Korea and Treatment Strategies

Background

Staphylococcus aureus is a well-known microbe that colonizes or infects the skin in atopic dermatitis (AD). The prevalence of methicillin-resistant S. aureus (MRSA) in AD has recently been increasing.

Objective

This study aimed to determine the antimicrobial susceptibility patterns in AD skin lesions and evaluate the prevalence of MRSA in Korea. We also recommend proper first-line topical antibiotics for Korean patients with AD.

Methods

We studied S. aureus-positive skin swabs (n=583) from the lesional skin of infants, children, and adults who presented to our outpatient clinic with AD from July 2009 to April 2012.

Results

S. aureus exhibited high susceptibility against most antimicrobial agents. However, it exhibited less susceptibility to benzylpenicillin, erythromycin, clindamycin, and fusidic acid. The prevalence of MRSA was 12.9% among 583 S. aureus isolates, and the susceptibility to oxacillin was significantly lower in infants in both acute and chronic AD lesions.

Conclusion

S. aureus from AD has a high prevalence of MRSA and multidrug resistance, especially in infants. In addition, the rate of fusidic acid resistance is high among all age groups, and mupirocin resistance increases with age group regardless of lesional status. This is the first study comparing the antimicrobial susceptibility rates of S. aureus isolates from AD cases with respect to age and lesion status in Korea.     

Molecular Analysis of Malassezia Microflora on the Skin of the Patients with Atopic Dermatitis

Background

The yeasts of the genus Malassezia are members of the normal flora on human skin and they are found in 75~80% of healthy adults. Since its association with various skin disorders have been known, there have been a growing number of reports that have implicated Malassezia yeast in atopic dermatitis (AD).

Objective

The aim of the present study is to isolate the various Malassezia species from AD patients by using 26S rDNA (ribosomal Deoxyribonucleic acid) PCR-RFLP and to investigate the relationship between a positive Malassezia culture and the severity of AD.

Methods

Cultures for Malassezia yeasts were taken from the scalp, cheek, chest, arm and thigh of 60 patients with atopic dermatitis. We used a rapid and accurate molecular biological method 26S rDNA PCR-RFLP, and this method can overcome the limits of the morphological and biochemical methods.

Results

Positive Malassezia growth was noted on 51.7% of the patients with atopic dermatitis by 26S rDNA PCR-RFLP analysis. The overall dominant species was M. sympodialis (16.3%). M. restricta was the most common species on the scalp (30.0%) and cheek (16.7%). M. sympodialis (28.3%) was the most common species on the chest. The positive culture rate was the highest for the 11~20 age group (59.0%) and the scalp showed the highest rate at 66.7%. There was no significant relationship between the Malassezia species and SCORing for Atopic Dermatitis (SCORAD).

Conclusion

The fact that the cultured species was different for the atopic dermatitis lesion skin from that of the normal skin may be due to the disrupted skin barrier function and sensitization of the organism induced by scratching in the AD lesion-skin. But there was no relationship between the Malassezia type and the severity score. The severity score is thought to depend not on the type, but also on the quantity of the yeast.     

Analysis of Colonization and Genotyping of the Exotoxins of Staphylococcus aureus in Patients with Atopic Dermatitis

Background

The skin of atopic dermatitis (AD) patients has a high susceptibility to Staphylococcus aureus colonization, and the toxins produced by S. aureus may aggravate AD by acting as superantigens.

Objective

The purpose of this study was to evaluate the relationship of the skin barrier function, colonization of S. aureus, and the clinical severity of AD. We also examined the predominant toxin genes produced in Korean AD patients.

Methods

Thirty-nine patients with AD were evaluated for clinical severity and skin barrier function by using Severity Scoring of Atopic Dermatitis (SCORAD) index and transepidermal water loss (TEWL). S. aureus was isolated from the forearm, popliteal fossa, and anterior nares of AD patients (n=39) and age-matched controls (n=40); the toxin genes were analyzed by performing multiplex polymerase chain reaction.

Results

TEWL showed a statistically significant correlation with clinical severity in patients with AD (p<0.05). TEWL was correlated with the number of S. aureus colonization sites and the presence of nasal colonization, but these results were not statistically significant. S. aureus strains were isolated in 64.1% of the 39 AD patients. The SCORAD index and AD severity were strongly correlated with the number of colonization sites. The predominant toxin gene found in AD patients was staphylococcal enterotoxin a (sea) only, which was produced in 52.6% of patients. The toxin genes sea and toxic shock syndrome toxin-1 (tsst-1) were found together in 42.1%, while tsst-1 only was found in 5.3% of the patients.

Conclusion

S. aureus strains were isolated in 64.1% of the 39 AD patients. Skin barrier function, as measured by TEWL, revealed a statistically significant correlation with clinical severity in AD patients. The SCORAD index and severity of AD was strongly correlated with the number of colonization. The most common toxin gene was sea in the Korean AD patients and this gene might have an important role in the pathogenesis of AD.     

丁酸氢化可的松软膏治疗儿童异位性皮炎临床疗效观察

目的:评价丁酸氢化可的松软膏治疗儿童异位性皮炎的临床疗效。方法:采用自身对照,治疗侧用丁酸氢化可的松软膏;对照侧用0.1％糠酸莫米松霜。结果:共观察了46例异位性皮炎患儿,丁酸氢化可的松软膏的有效率为84.78%,0.1％糠酸莫米松霜的有效率为91.30％,二者差异无显著性(x2=0.93,P>0.05)。二组均未观察到明显的不良反应。结论:丁酸氢化可的松软膏是一种高效、安全的外用皮质类固醇激素制剂,可以应用于治疗儿童异位性皮炎。     

镇心安神法对特应性皮炎患者临床症状的影响

目的评价镇心安神法代表方剂龙牡汤对青年及成人期特应性皮炎患者临床症状和复发情况改善的影响。方法采用随机、西药平行对照的方法对122例青年及成人期特应性皮炎患者给予中药龙牡汤或氯雷他定片联合0.1%丁酸氢化可的松乳膏,治疗前及治疗后第1,2,4,8周记录皮肤病变面积、皮损严重程度、瘙痒程度,计算SCORAD分值,治疗8周后对痊愈及显效患者2个月后随访并记录复发情况。结果中、西药组各自治疗前后各项症状、SCORAD分值比较差异有统计学意义(P<0.05),两组治疗后各项积分、SCORAD分值比较差异无统计学意义(P>0.05),中药组复发率低于西药组,二者比较差异有统计学意义(P<0.05)。结论镇心安神法可明显改善青年及成人期特应性皮炎患者的临床症状,有效减少复发。     

The Clinical Efficacy, Safety and Functionality of Anion Textile in the Treatment of Atopic Dermatitis

Background

Several previous studies have suggested the improvement of atopic dermatitis (AD) in response to special fabrics. In particular, beneficial effects have been reported, following the use of anion textiles.

Objective

The purpose of this study is to evaluate the effectiveness and safety of an anion textile in patients suffering from AD.

Methods

We compared an anion textile with a pure cotton textile. Fifty-two atopic patients (n=52) were enrolled and divided into two groups. The patients in the test (n=25) and control (n=19) groups wore undergarments made of an anion textile or pure cotton over a period of 4 weeks. The overall severity of disease was evaluated using the SCORing atopic dermatitis (SCORAD) index, whereas, the treatment efficacy was measured using a Tewameter® (Courage & Khazaka, Cologne, Germany), Mexameter® (Courage & Khazaka) and Corneo meter® (Courage & Khazaka).

Results

At the end of the study, a significant decrease in the SCORAD index was observed among the patients with AD in the test group (mean SCORAD decreased from 47.2 to 36.1). Similarly, improvements in the mean transepidermal water loss, skin erythema and stratum corneum hydration were significantly greater among the patients with AD in the test group than in the control group.

Conclusion

Anion textiles may be used to significantly improve the objective and subjective symptoms of AD, and are similar in terms of comfort to cotton textiles. The use of anion textiles may be beneficial in the management of patients with AD.     

Effect of Probiotics on the Treatment of Children with Atopic Dermatitis

Background

Atopic dermatitis, a chronic recurrent disease, is frequently encountered in clinical practice. In the last 30 years, the prevalence of atopic dermatitis has rapidly increased due to industrialization. Therefore, there have been attempts in recent years to find new ways of treating and preventing atopic dermatitis.

Objective

In this double-blind, randomized, placebo-controlled study, a combination of Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius strains were evaluated in the treatment of atopic dermatitis in pediatric patients.

Methods

Forty pediatric patients (23 males and 17 females) aged 1~13 years were enrolled. One eligible individual who was approached declined to participate. The probiotic group was administered a probiotic complex containing B. bifidum, L. acidophilus, L. casei, and L. salivarius for 8 weeks. The placebo group, on the other hand, was administered skim milk powder and dextrose. All of the parameters including serum cytokines, eosinophil cationic protein), SCORing Atopic Dermatitis (SCORAD) index, and total serum immunoglobulin E (IgE) were measured in both the probiotic group and the placebo group at the end of 8 weeks.

Results

Probiotic intervention in pediatric atopic dermatitis patients effectively reduced the SCORAD index and serum cytokines interleukin (IL)-5, IL-6, interferon (IFN)-γ, and total serum IgE levels, but did not reduce levels of serum cytokines IL-2, IL-4, IL-10, ECP, or tumor necrosis factor-α (TNF-α) compared to the placebo group.

Conclusion

Our study found probiotics to be effective in reducing atopic dermatitis patients'' SCORAD index, serum IL-5, IL-6, IFN-γ, and total serum IgE levels but not effective in reducing serum IL-2, IL-4, IL-10, ECP, or TNF-α levels.     

Staphylococcus aureus Colonization in Acute and Chronic Skin Lesions of Patients with Atopic Dermatitis

Background

Staphylococcus aureus (SA) has peculiar abilities to colonize the skin in atopic dermatitis (AD) patients.

Objective

We sought to determine the colonization rates of SA in acute and chronic skin lesions of AD patients, to find any difference in colonization rates according to age and to find the influences of total immunoglobulin E (IgE) and eosinophil counts to the colonization of SA.

Methods

We evaluated the total IgE level and eosinophil counts, and cultured SA from the skin lesions of 687 AD patients (131 acute and 556 chronic skin lesions) and 247 control urticaria patients (July 2009 to November 2010; Samsung Medical Center Dermatology Clinic, Seoul, Korea).

Results

The SA colonization rates were 74%, 38% and 3% in acute, chronic skin lesions and control skin, respectively, and they were increased with age in AD patients. The colonization rate in chronic skin lesions was higher in the high IgE/eosinophilia groups as compared to the normal IgE/eosinophil groups.

Conclusion

The SA colonization rate was higher in AD patients and especially in acute lesions, and had a tendency to increase with age. As the colonization rates were only higher in the high IgE/eosinophilia groups of chronic skin lesions, we suggested that SA may invade the skin through barrier defects in acute skin lesions, but the colonization in chronic lesions may be orchestrated through many different factors.     

Current Understanding in Pathogenesis of Atopic Dermatitis

There have been advances in our understanding of the complex pathogenesis of atopic eczema over the past few decades. This article examines the multiple factors which are implicated in this process.     

Intravenous Immunoglobulin Treatment in a Child with Resistant Atopic Dermatitis

In a subgroup of patients suffering from atopic dermatitis (AD), treatment is quite difficult even after taking oral immunosuppressants. High-dose intravenous immunoglobulin (IVIG) treatment has been reported to be beneficial for them in a few uncontrolled trials. Herein we report a case of intractable AD in a 5-year-old girl who had significant clinical improvement after receiving 3 cycles of IVIG treatment (2 g/kg) without notable side effects. Since the first infusion of IVIG, the patient''s skin lesions improved steadily and the improvement persisted until the 8-month follow-up. The eczema area and severity index score decreased remarkably, while immunologic parameters did not correlate with clinical improvement. This case suggests that IVIG therapy can be quite effective and safe for children with resistant AD.     

复曲膏治疗异位性皮炎的临床观察

目的探讨自制复曲膏治疗异位性皮炎的临床疗效及不良反应。方法83例患者随机分为3组,治疗一组外用复曲膏,治疗二组外用复曲膏联合肌注斯奇康注射液,对照组用复方康纳乐霜,共治疗3周。结果复曲膏治疗两组痊愈率分别为43.33%和61.54%,有效率分别为80%和92.31%,均显著高于对照组(P<0.05,P<0.01);治疗二组的复发率明显低于治疗一组(P<0.05)。无明显不良反应。结论复曲膏治疗异位性皮炎疗效确切,尤其与斯奇康注射液联合应用疗效更好。     

Atopic Dermatitis; Etio-Pathogenesis,An Overview

Atopic dermatitis is a well-recognized clinical entity, several facets of which continue to be mystified. Accordingly, its etio-pathogenesis is largely elusive. It appears to be an outcome of interplay of several undertones, namely: genetics, maternal factor and inheritance, pregnancy/intrauterine, environmental factors, immune dysregulation, immuno-globulins, role of diet, and infection. Besides, recent innovative breakthroughs consisting of nutritional supplementation, the highlights of which were considered worthwhile to take stock of to define its current status. An endeavor to enlighten the audience has been made for their benefit.     

湿包裹治疗儿童重度特应性皮炎的疗效观察

目的 观察湿包裹(WWT)治疗儿童重度特应性皮炎(AD)的疗效和安全性.方法 2018年9月-2019年9月在南京儿童医院皮肤科门诊诊断为重度AD的患儿(符合Williams诊断标准,SCORAD ＞50分)40例,随机分为WWT组(n =20)和传统治疗组(n=20).WWT组采用0.1％糠酸莫米松乳膏联合2％莫匹罗...     

Atopic Dermatitis: Clinical Connotations,Especially a Focus on Concomitant Atopic Undertones in Immunocompromised/Susceptible Genetic and Metabolic Disorders

Atopic dermatitis (AD) is an intriguing clinical entity. Its clinical connotations are varied, the updates of which are required to be done periodically. An attempt to bring its various facets have been made highlighting its clinical features keeping in view the major and the minor criteria to facilitate the diagnosis, differential diagnosis, complications, and associated dermatoses. The benefit of the current dissertation may percolate to the trainees in dermatology, in addition to revelations that atopic undertones in genetic susceptibility and metabolic disorder may provide substantive insight for the future in the understanding of thus far enigmatic etiopathogenesis of AD.     

The Influence of Pregnancy and Menstruation on the Deterioration of Atopic Dermatitis Symptoms

Background

Female patients with atopic dermatitis (AD) often experience cutaneous deterioration associated with their pregnancy or menstrual cycle.

Objective

We wanted to determine the prevalence of symptom aggravation as related to pregnancy and the menstrual cycle in female patients with AD.

Methods

One hundred female patients with AD were included in the study and interviews were performed. The total IgE level and the Eczema Area and Severity Index score of the patients were retrospectively reviewed.

Results

Ninety seven patients replied the questionnaire, and among them, 23 patients had completed at least 1 pregnancy. Among the 23 women who experienced pregnancy, 14 (61%) had noticed deterioration of their clinical symptoms during pregnancy. Of the 97 females, 31 (32%) patients had noticed deterioration of their AD as related to their menstrual cycle. For the patients who were sub-grouped as the intrinsic type of AD, the prevalence of symptom aggravation as related to pregnancy was significantly higher as compared to that of the extrinsic type of AD patients (p=0.048).

Conclusion

Of the 97 patients, 45 (46%) females answered that they have experienced deterioration of AD during pregnancy or in relation to their menstrual cycle, and this suggests the relation of a hormonal influence on the clinical manifestations of AD.     

Evidence - Based Pharmacological Treatment of Atopic Dermatitis: An Expert Opinion and New Expectations

Atopic dermatitis (AD) is one of the most common skin diseases with a complex multifactorial background. The clinical presentation, the aggravating factors and the complications vary according to the age of the patients. Most cases, approximately 60-80%, present for the 1^st time before the age of 12 months. Adult-onset AD has been observed as a special variant. Pruritus is the worst sign of AD, which also often indicates an exacerbation and is considered to be the most annoying symptom of AD. Treatment is preferably started based on the severity of AD. In only 10% of the cases, AD is so severe that systemic treatment is necessary. Systemic treatment including topical wet-wrap treatment is indicated in the worst and recalcitrant cases of AD. Systemic treatment of AD is discussed with regards to the evidence-based efficacy and safety aspects. I prefer wet-wraps as a crisis intervention in severe childhood cases, whereas UV and systemic treatments are the choices in patients older than 10 years. Probiotics are not useful in the treatment. If they have any effect at all it may only be in food-allergic children with AD. Finally, anti-histamines are not effective against pruritus in AD. They are only effective against urticarial flares and in cases with food-allergy. This article consists of an expert opinion on evidence-based pharmacological treatment of AD, but it is not a systemic review.